Lessons From the Pandemic for Oncology Pharmacy

As a direct result of the global pandemic, the landscape for oncology health care professionals has changed. Additionally, there has been a significant shift within the pharmaceutical industry and its strategy and tactics relative to managing oncology products and services within the cancer community.

Another Breakout Year for Oncology Approvals

Despite the challenges of the pandemic, 2020 proved to be a robust year for new drug approvals, including a significant number of oncology therapies, as the FDA successfully shifted gears to a higher level to keep pace. Oncology products came out on top with new approvals for a wide variety of cancer types, including 12 treatments for lung cancer.¹ In 2021, there may be an even greater uptick in new approval because the pandemic made it challenging for FDA staff to do the necessary inspections required to approve some products. A vaccinated and protected agency may be able to expedite those approvals this year. Many eyes are on the new administration to see if whether they continue this momentum.

The Oncology Product Supply Chain Is Complex

Because I have been involved in the pharmaceutical supply chain for years, people often ask me exactly what I do professionally. It’s easier to tell them I’m a pharmacist rather than explain the complexities of the oncology specialty industry. Coronavirus disease 2019 (COVID-19) vaccines and their handling suddenly made the specialty pharmaceutical supply chain a household word, and it made the headlines of every newspaper around the globe. The oncology industry and oncology pharmacists have been experts in the movement and management of their products, particularly with the number of specialty therapies that mandate different manufacturing and distribution processes over the more traditional products.

The supply chain process requires tight integration among various stakeholders, from the point of manufacturing and packaging to product administration. Pharmacists have learned that the best supply chain starts with a patient-centric approach and works back upstream from this anchor point—understanding the role that each stakeholder plays in the process and supporting specific needs and touchpoints along the path. There must be transparency and quality communication, leveraging technology wherever possible to link those stakeholders in real time. Patient and product safety is always paramount so that standardized processes are understood and enforced to assure high-quality and access. Given the high cost of oncology products, payers must be integrated into the mix to ensure vital medications are paid in a timely manner. So much of what the pharmaceutical industry does is outsourced; therefore, platforms must be developed based on standards and interchangeability. The Drug Supply Chain Security Act outlines steps to build an electronic, interoperable system to identify and trace certain prescription drugs as they are distributed in the United States.

Oncology Pharmacists Are Patient Navigators

Health care is a decentralized process, and although great strides have been made to integrate workflows, it still takes patient advocates and navigators to assist in the process. Oncology pharmacists have aggressively stepped into this very important role. Although the goal of the industry has been to provide new and innovative therapies to treat new and existing cancers, these products often come at a high price.

The oncology pharmacist’s role is to navigate through the bureaucracy as the patient’s advocate on behalf of the oncology team. With the pandemic, the role of the oncology pharmacy team has required even greater coordination to ensure medication therapy goals are met in a patient-centric manner. The pandemic pushed institutional facilities and personnel to operate on overload. The oncology pharmacy team continued to put patients first and responded to the pandemic by creating innovative practices to help triage patient care. Oncology pharmacists have seen a shift to oral oncology products as alternatives to clinic- or institutionally infused products where possible. Given this is more of a specialty pharmacy benefit, the role of the oncology pharmacy team has never been greater.

The good news is that after 2020, there will be nearly 20 new oncology products to integrate into the therapy mix. Also, in 2020, pharmacists saw major attempts to help manage drug costs, but most will either not get off the ground with the new presidential administration or may be adopted with even greater vigor. Either way, the oncology pharmacist will be in the center.

There has been a shift with government-sponsored programs to increase access to specialty products using newer tactics such as value-based pricing. The oncology pharmacy team has been instrumental in tying many of the elements together, measuring oncology product treatment value to assure patient access and drug coverage. Manufacturers and oncology pharmacist have come to better align their goals around these elements to help provide an accurate reflection of a product’s effectiveness in treating cancers.

Oncology Pharmacy and Brand Managers

The oncology pharmacy is charged with obtaining access and payment for products, followed by administration or the dispensing process. This may include working with the manufacturer’s hub.

Manufacturers have invested tremendous resources to assist the patient and the oncology team in getting the most value out of their products. This partnership is established by sharing data and communications, often through this publication, Directions in Oncology Pharmacy^®. Brand managers have come to realize, through this pandemic, the importance of written communication in digital or print.

Oncology product managers are dedicated to directing programs designed to support patients through their care journey, using the products for which they are responsible. With oncology pharmacists, the patients they serve and data they manage are instrumental in linking all the services together. The industry realizes and supports this process through education and resources, giving oncology pharmacists the tools to get the job done. Directions in Oncology Pharmacy^® has a large portfolio of tools to facilitate this process that extends far beyond the publication.

Technology Enhancements in Oncology Pharmacy

The pandemic has forced technology to the forefront of health care in oncology pharmacy. Pharmacists witnessed a tectonic shift in work and health care environments, driven by the adoption of telehealth and other technologies assisting in getting through this crisis. The pandemic continues to be a great disruptor of health care; however, technology has enabled the oncology industry to broaden its reach beyond the 4 walls of the institution to enter the home of the patient, thereby insulating them in the risk of exposure to pathogens. By minimizing face-to-face interaction to the most urgent cases, a paradigm shift will, with hope, sustain itself past the pandemic.

Health care has been generally viewed as a locally managed process. Through technology, many patient care elements can be accessed and supported remotely or on a more national basis. Post pandemic, there may be a more hybrid approach to patient care in oncology pharmacy. Oncology pharmacists will need to be embedded with the overall oncology team, supporting oncologists and nurses. However, they have demonstrated that follow-up and support can take place through technology, saving time and resources or, importantly, expanding the net of patient care. Some see this as a reimbursable process through collaborative practice agreements in place with providers and payers in support of oncology pharmacy.

Staying Oncology Patient Centric Through Data

If oncology pharmacists learned anything through the ongoing pandemic process, it’s that they must adapt quickly. Treating cancer is not something that can be put off to a later day like a haircut or even elective surgery. It must be met head-on and aggressively managed despite the pandemic. It takes a potent mix of empowered oncology pharmacists and patients together with their caregivers to get this done, and there is no one-size-fits-all approach.

At the heart of quality patient care is the patient, but to understand and share this information, the oncology pharmacist must leverage useful data. Documentation and data sharing are the cornerstones of how quality oncology patient management programs are optimized. Oncology pharmacy utilizes accurate and predictive analytical tools enhanced through artificial-like intelligence to help identify and engage patients with cancer through the various stages of their care.

Oncology pharmacy is responsible for acting on data to facilitate a greater outcome for the patient. Data help identify disease faster in oncology, and with precision medicine, the information assures the right drug is tailored to the right patient based on their diagnosis. Patient-centric data are key.

After a treatment plan is collaboratively established with the oncology team, it is the oncology pharmacist’s role to ensure drug therapy is implemented. The oncology pharmacist can leverage data to check patient adherence through education and understanding.

Dan Steiber, RPh, operates Genesis Pharma Consultants, a consulting practice responsible for commercial operations and trade-supply chain strategy development. Steiber has served in several senior positions in pharmacy, distribution, and industry over the course of his 40-year career. Steiber is a licensed pharmacist in Texas, Washington, California, and Pennsylvania. He is affiliated with several professional associations and publications and a frequent speaker on behalf of many professional organizations. Steiber graduated from Washington State University College of Pharmacy. He has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University and Northwestern University.

REFERENCE

• 2020: a strong year for new drug therapy approvals-despite many COVID-19 challenges. FDA. January 8, 2021. Accessed January 20, 2021. https://www.fda. gov/news-events/fda-voices/2020-strong-year-new-drug-therapy-approvals-despitemany-covid-19-challenges